by abby l. bacon. at the time of hiring a new employee, it is unknown whether precipitating factors...

Nurse Hiring & Retention Issues

By Abby L. Bacon

At the time of hiring a new employee, it is unknown whether precipitating factors are present that may contribute to the departure of the registered nurse within one year from the date of hire.

Statement of the problem

The purpose of this study is to explore possible precipitating factors before employment that may lead to the departure of a registered nurse from a critical access hospital (CAH) in South Dakota within one year from the nurse’s original hire date.

Purpose of the study

What are the precipitating factors present at the time of hire that may contribute to the registered nurse departing a CAH of South Dakota within one year of the original date of hire?

Research Question

SignificanceAffects of high turnover among nurses

• Cost is considerably high

• Outcomes of a facility decline

• People (staff and patients) are directly and negatively affected

• Productivity decreases

• Staff can become more negative leading to an increased turnover

Critical access hospital (CAH) ◦ a hospital certified to receive reimbursement from Medicare

Precipitating factor ◦ element that causes or contributes to the occurrence of a disorder or problem

Registered Nurse ◦ Approved/accredited school of nursing, passed NCLEX, active license

Definitions

Factors relating to increased turnover Job Satisfaction

◦ (Parry, 2008) (Ma, Lee, Yang, & Chang, 2009) (Lai et al., 2008) (Klug, 2009)

Poor management ◦ (Morgan & Lynn, 2009) (Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010)

Decreased salary/benefits ◦ (Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010) (Chan and Morrison, 2000)

Review of the Literature

Factors relating to increased turnover Intent to stay or leave

◦ (McCarthy, Tyrell, & Lehane, 2007) (Klug, 2009)

Job embeddedness ◦ (Mitchell, Holtom, Lee, Sablynski, & Erez, 2001) (Holtom & O’Niell, 2004)

Nurse’s health & the physical workload ◦ (Lai et al., 2008) (Atencio, Cohen, & Gorenberg, 2003)


Factors relating to increased turnover Nurses’ attitudes, dedication, and perception of work

◦ (Lu, While, & Barriball, 2007) (Chan & Morrison, 2000)

Work environment ◦ (Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010) (Chan & Morrison, 2000)

Other External Factors◦ (Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010)


Theory of planned behavior The factors include behavioral attitude, subjective norms,

& perceived behavioral control

Describes the relationship between attitudes and behavior

The best predictor of behavior is one’s intent to behave

These factors influence intention and thus behavior.

Conceptual framework

Model

Based on the Theory of Planned Behavior

Behavior : factors may be present at the time of hire affecting the intent of the nurse that result in voluntary departure

Attitudes: positive and negative beliefs about the behavior

Subjective norms: perception of social pressure

Behavioral control: Perceived ability to control the behavior.

Conceptual Frameworkrelated to this study

A typical descriptive study design will be used for this qualitative study

A descriptive design is ideal for discovering areas of concern within a current practice where little information is known

Research Design

Registered nurses included in the sample must have the following

Be previously employed by CAH in South Dakota

Worked less than one year before voluntarily leaving the facility

Completed a course of study at an approved/accredited school of nursing

Passed the National Council of Licensure Examination.

Have an active license at the time of the study.

Sample

Facility is critical access hospital of South Dakota

The location is where each of the subjects were employed prior to departure

The survey includes the number of beds, the number of registered nurses employed by the facility, and the number of open positions for registered nurses.

Study Setting

Approval from Human Subjects Committee at SDSU and the internal review board of the participating CAHs.

A survey will be mailed to HR dept. of the CAHs of SD

Each department will forward the questionnaire to 10 RNs

◦ RN voluntarily stopped working, employed for less than one year

Include letter about the study, the confidentiality, and return steps

Include a stamped, return envelope for convenience of returning survey

Study Procedure

A self-reported questionnaire

1. Demographics of nurses (age, gender, years of nursing experience)

Information of their hospitals (# of beds, # of RNs, # of open positions)

2. Statements to be answered with a likert scale response◦ 1 meaning strongly agree to 5 meaning strongly disagree.

3. Fill-in-the-blank statement, ◦ Labeled as internal or external & if it was present at the time of hire.

Instrument

Demographics: Gender: Male or Female; Age: ____; Number of years as a nurse? _____

Hospital: beds _____, RN’s employed _____; open RN positions _____

Answer the following with the number 1 through 5

1 – Strongly Agree, 2 – Agree, 3 – Undecided, 4 – Disagree, 5 – Strongly Disagree

1 2 3 4 5 The factor that lead me to leave my position was present at the time I was hired

1 2 3 4 5 My perception of rural health nurse requirements affected me leaving

1 2 3 4 5 When I was hired, I understood the position required knowledge of multiple areas

1 2 3 4 5 Only work related factors lead me to leave my position

1 2 3 4 5 Only personal related factors lead me to leave my position

Complete the following of as many that apply to you

Name a factor for you leaving your current position in the CAH.

____________________________________________________

Was the factor external (personal related) or internal (work related)

Was this factor present at the time you were hired? Y N

(Last section is repeated three more times on actual survey)

Sample of the Survey

Demographic data will be analyzed using frequencies and percentages.

Statement answers will be analyzed using frequencies and percentages.

Fill-in-the-blank statements categorized into themes or patterns.

Categorized factors into internal/external & if present at the time of hire.

The researcher will focus on factors that were present when the nurse was hired.

Present all of the data in narrative and graph form

Projected Analysis

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